The role and place of Nuclear Magnetic Resonance Therapy

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THE ROLE AND PLACE OF NUCLEAR MAGNETIC RESONANCE THERAPY (MBST®) IN THE THERAPEUTIC TREATMENT IN SPINAL PAIN WITHOUT ROOT SYMPTOMS, WITH ROOT SYMPTOMS AND IN SPONDYLOARTHROSIS.

Introduction

The pain of the spine, its location, radiation towards the limbs have their reflection in structural changes of the spine within discs, ligaments, intervertebral joints and roots. The nucleus pulposus, which does not have its own vessels and innervation, is immunologically a foreign body. It is surrounded by a fibrous ring, consisting of several dozen layers. Unlike the nucleus pulposus, the fibrous ring is very richly innervated and vascularized.
In the first stage of the discopathy, the patient reports pain located around the sick section of the spine, which intensifies in static positions / standing for prolonged periods of time, sitting, assuming non-physiological positions / when starting to move. The reason for this pain is damage to the fibrous ring, which leads to contact between the nucleus pulposus and blood. This causes a number of immunological reactions. Magnetic Resonance Imaging (MRI) shows disk dehydration and filling the concave posterior surface.

In the second stage of disc disease, more layers of the fibrous ring get damaged, which results in its increased dehydration and increased nucleus pulposus protrusion, increasing immunological symptoms and intensifying pain. At this stage of the disc disease, the patient is able to indicate an aching spot and reports more pain which hinders their daily activities.
If further layers of the fibrous ring are damaged, the disc protrusion will build up. The increasing protrusion causes narrowing of the spinal and root canals, reducing fluid space and pressing on the root. The patient reports pain radiation to one or both upper limbs in cervical disc damage, intercostal neuralgia in thoracic disc damage, radiation to lower limbs in lumbar disc damage. This is the third and final stage of disc disease, which often requires surgical treatment. MRI shows a large protrusion, which significantly reduces fluid space, narrows the spinal and root canals. In this last stage of disc disease, if there is no neurological loss in the limbs, we qualify the patient for conservative treatment. If the ring is completely damaged and there are neurological defects, we also qualify the patient for surgical treatment.

Spondyloarthrosis is the result of long-term disc disease. On an MRI scan we see complete disc dehydration / black disc / reduction of interbody space, high stenosis of the spinal and root canals, steatosis of the vertebral body and degenerative changes that also occur at the intervertebral joint level. The patient reports pain that awakens them at night, starting pain in the morning, during prolonged static positions, pain that hinders daily activities and causes a significant reduction in movement within the spine.

Objective of the study

The aim of the study is to show the place of MBST® therapy and its influence on the final effect of treatment at individual stages of disc disease without root symptoms, with root symptoms and in spondyloarthrosis. In our therapy, we start treatment of spinal pain with MBST®. We combine MBST treatments with manual therapy, as well as with teaching exercises that the patient performs every day at home to maintain satisfactory treatment results. I consider this therapy as a stimulation of the repair processes at the cellular level in order to reverse degenerative changes, improve the discs hydration and accelerate the repair processes of the fibrous ring. Re-isolation of the nucleus pulposus from the bloodstream will interrupt immunological reactions and reduce or relieve pain.

In advanced disc damage and spondyloarthrosis I combine the above mentioned physiotherapy with DiscoGel implantation into damaged discs, supravenous administration of autologous serum in the GOLDIC® method, administration of MD Neural® collagen into intervertebral joints, sinuertebral blocks, root blocks with 6.3 mg/ml Diphropose and 1% Lignocainum.

Method

In the first stage of disc disease, patients’ treatment began with MBST®, manual therapy and exercises performed at home. MBST® therapy (disk program) is used to stimulate natural processes of repairing the damaged fibrous ring, stop immunological processes and increase hydration of the nucleus pulposus.

MBST® treatments are always combined with manual therapy to increase the mobility of the spine and relieve the burden of damaged discs and roots, and with teaching the exercises the patient has to do at home to maintain good spinal mobility and dynamic stability. At each checkup I verify the knowledge of the exercises, I recall them, and correct errors. The effect of treatment in patients who regularly exercise at home is much better than in patients who do not do so. One year after the therapy, I perform a follow-up MRI to assess the effect of the treatment.

In patients in the second stage of disc disease I combined MBST® with manual therapy with DiscoGel implantation. We administer DiscoGel into damaged discs to heal the fibrous ring, interrupt the immunological symptoms, reduce the protrusion and improve the hydration of the disc. DiscoGel® administration is performed in the operating room and monitored by the TV X-ray machine. Having administered the gel, the patient lies in the postsurgical room for 3 hours. He returns home in a supine position.

For the first 2 weeks the patient stays at home, they can walk or lie down. Sitting down must be kept to a minimum. Two weeks after the administration of DiscoGel, the patient’s checkup is performed. If the pain related to the administration of DiscoGel® has disappeared, the patient can sit or drive for up to 1.5 hours at a time. A non-intensive lifestyle is still recommended for the next 2 weeks. At home, the patient starts to perform the exercises he was previously taught. After 4 weeks from the administration of DiscoGel® and after the checkup, the patient is qualified for manual therapy if the restriction of movement within the spine is maintained or if he or she returns to the previous lifestyle and motor activity. He or she continues to exercise at home. After one year we perform a control MRI in order to objectively assess the improvement of structural changes within the discs.

In patients in the third stage of disc disease with root symptoms during the above mentioned medical procedures, we additionally perform peritoneal root blockades under ultrasound or TV X-ray with 6.3 mg/ml Diprophos and 0.5% – 1% Lignocainum. In case of a strong root path without neurological defects, we perform the blockade at the very beginning and wait a few days. If the root symptoms are significantly reduced or disappear, we start the therapy. If, after one or two blockades, the root symptoms do not change, the patient is qualified for endoscopic decompression of the root. After 2-3 weeks from the operation, we perform physiotherapy: MBST® with manual therapy and exercise teaching.

We treat patients with spondyloarthrosis on a case by case basis. We are guided by clinical symptoms and MRI. In patients with starting pain, severe limitation of movement, steatosis of the vertebral bodies in MRI, MBST® is performed for bone metabolism. In patients with structural and dysfunctional changes, significant degree of sinuertebral neuralgia, or slight vertebral degenerative steatosis, we perform MBST® on nervous tissue and bone metabolism. MBST® therapy is always combined with manual therapy and exercise teaching.

Material

The assessment involved 100 patients aged 18 to 86 years, including 58 women and 42 men with chronic spinal pain. In order to standardize and increase representativeness, patients were divided into three clinical groups. The first group of patients with spinal pains without root symptoms was the most numerous. The second group consisted of patients with root symptoms, without neurological defects. The third group included patients with spondyloarthrosis. The groups were established on the basis of the history, physical examination and magnetic resonance imaging (MRI).

Testing procedurę

In the first group of patients MBST®, manual therapy and learning exercises were applied. In the second stage DiscoGel® was implanted in patients with disk dehydration and protrusion.

In the second group of patients a root block was applied in order to relieve the root symptoms. In the second stage MBST® and manual therapy were applied. In the third stage DiscoGel® was implanted into damaged discs.

In the third group of patients with spondyloarthrosis, MBST®, manual therapy and exercise teaching were applied firs. If the pain persisted, sinuvertebral blockades from Diprophos/Lignocaine were performed or GOLDIC® and MD Neural® collagen to the intervertebral joints were administered.

Test results

Patients were evaluated on the VAS and Functional Scale according to the Revised Oswestry Low Back Pain Disability Scale, after 6, 12 and 18 months.

In the first group of patients:

Pain intensity: severe pain of a constant intensity and periodically subsiding. After the MBST®, manual therapy and exercise teaching, some patients are given DiscoGel® – into damaged discs. The pain has decreased to a level of mild, spontaneously subsiding pain.
Before the therapy, patients could lift very light weights or objects not too heavy, arranged in a convenient way. After the therapy, patients could lift heavy objects conveniently positioned or off the floor.
Before the therapy, the pain did not allow patients to sit for more than ten minutes, half an hour or at all. After the therapy, they could sit as long as they wanted, without experiencing pain.
Patients slept ½ or ¼ nights before the therapy. After the end of the treatment, patients lying in bed felt no pain and slept all night.
Before the start of the therapy, the pain restricted or made traveling impossible. After the therapy, the patients did not feel any pain while travelling.
Personal care (washing, dressing, undressing, etc.) intensified the pain, forcing patients to change the way they performed these activities or requiring help with certain activities. After the therapy, patients did not have to change the way they performed their daily activities because of the pain.
Before the therapy, the pain prevented patients from walking more than 400 – 800 m, after the therapy, the pain did not prevent the patient to walk any distance.
The pain prevented the patients from standing more than 10 minutes due to the increase in pain intensity. After the treatment, the pain did not restrict standing.
Before the treatment, the whole social life was limited to very rare leaving home or meetings at home. After the treatment, the social life became normal and did not cause any pain.
Before the therapy the pain used to intensify quickly, after the treatment the pain either has subsided or a small amount of pain felt by the patients diminishes quickly.

On the VAS scale:
– After 3 – 6 months the pain during everyday activities was reduced from 7 to 0;
– After 6 – 12 months observation, pain remained at level 1,
– After 12 – to 18 months, the pain remained at level 1.

Questionnaire Revised Oswestry Low Back Pain Disability Scale:
Before treatment: moderate disability (15 – 24 points).
From 3 to 18 months – no disability (0 – 4 points). The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting and exercise.

In the second group of patients:

Pain intensity: severe pain of a constant intensity and periodically subsiding in a proper position. After the root block, MBST®, manual therapy and exercise teaching, in some patients DiscoGel® is administered into damaged discs. The pain has decreased to a level of mild, spontaneously subsiding pain.
Before the therapy, patients could only lift very light weights. After the therapy, patients could lift heavy weights if they were conveniently positioned.
Before the therapy, the pain did not allow the patients to sit longer than 10 minutes or at all. After the therapy they could sit as long as they wanted without pain.
Patients were able to sleep a quarter of a night before the therapy. After the treatment, the patients felt no pain while lying in bed and slept all night.
Before the start of the therapy, the pain prevented them from travelling. After the therapy the patients did not feel any pain while driving or felt some pain while travelling, but the pain did not intensify during standard travelling conditions.
Performing care activities (washing, dressing, undressing, etc.) intensified the pain, which required assistance with certain activities. After the therapy, patients do not have to change the way they perform their daily activities due to the lack of pain, or they experience mild pain that does not require a change in the way they wash or dress.
Before the therapy, the pain prevented patients from walking over 400 m, after the therapy the pain did not limit the patient to any distance.
The pain prevented the patient from standing to 10 minutes, due to the increase in pain intensity. After the treatment, the pain did not limit standing or there was mild pain that did not limit standing.
Before the treatment, the whole social life was limited to meetings at home. After the treatment, the social life became normal and did not cause any pain.
Before the therapy, the pain quickly intensified, and after the treatment, the pain felt by the patients subsides quickly.

On the VAS scale:
– After 3 – 6 months: the pain during everyday activities was reduced from 7 to 0;
– after 6 – 12 months: the pain remained at level 1,
– After 12 – 18 months: the pain remained at level 1.

In the third patient group:

Pain intensity: severe pain of a constant intensity and periodically subsiding. After MBST®, manual therapy and learning to exercise, sinuertebral blocks, cryolescence, the pain has decreased to the level of mild, spontaneously subsiding pain.
Before the therapy, patients could only lift very light weights to medium weights, conveniently positioned. After the therapy, patients could lift heavy weights, conveniently positioned.
Before the therapy, the pain did not allow the patients to sit for more than one hour. After the therapy they could sit as long as they liked, without pain.
Patients slept half the night before the therapy, woke up during the change of position or the pain woke them up at night. After the treatment, the patients did not feel any pain while lying in bed and slept all night.
Before the treatment commenced, the pain restricted or made traveling impossible, or restricted the patients to short necessary journeys under 30 minutes. After the therapy, the patients did not feel any pain while travelling or felt mild pain, but none of the forms of travelling increased the pain.
Personal care (washing, dressing, undressing, etc.) intensified the pain, forcing patients to change the way these activities were performed, or patients needed help with certain activities. After the therapy, patients did not have to change the way they performed their daily activities because of the pain. Occasional mild pain did not cause any difficulty.
Before the therapy, the pain prevented patients from walking more than 400m, after the therapy, the pain did not limit the patient’s ability to walk any distance.
The pain limited the patient’s standing to more than 10 minutes due to increasing pain intensity. After treatment, the pain did not limit standing. In some patients there was mild pain, but it did not increase.
Before the treatment, the whole social life was limited to very rare going out or meetings at home. After the treatment, the social life became normal and did not cause any pain.
Before the therapy, the pain quickly intensified, after the treatment the pain subsided or a small amount of pain felt by the patients subsides quickly.

On the VAS scale:
– After 3 – 6 months the pain during everyday activities was reduced from 8 to 1;
– After 6 – 12 months of observation, pain remained at level 1.5,
– After 12 – 18 months, the pain remained at level 1.5. Mild pain was experienced during various everyday activities, but did not limit them.

Questionnaire Revised Oswestry Low Back Pain Disability Scale:
Before treatment: severe disability (25-34)
From 3 to 18 months – no disability (0 – 4 points). The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting and exercise.

Conclusion

Spinal pain is a chronic disease that limits everyday activities and therefore requires systematic treatment, on a case by case basis.

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Daniel Kozyra

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